Healthcare Provider Details

I. General information

NPI: 1417015207
Provider Name (Legal Business Name): MEMORIAL COMMUNITY HOSPITAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4929 COUNTY ROAD P43
FORT CALHOUN NE
68023-5066
US

IV. Provider business mailing address

4929 COUNTY ROAD P43
FORT CALHOUN NE
68023-5066
US

V. Phone/Fax

Practice location:
  • Phone: 402-468-4655
  • Fax: 402-468-4633
Mailing address:
  • Phone: 402-468-4655
  • Fax: 402-468-4633

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number79001
License Number StateNE
# 2
Primary TaxonomyY
Taxonomy Code261QR1300X
TaxonomyRural Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: AMY ZIMMER
Title or Position: CNE/VP PATIENT CARE SERVICES
Credential:
Phone: 402-426-2182